NPI | 1679984165 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP125649) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP125649) |
Enumeration Date | 2014-05-19 |
Last Update Date | 2025-01-03 |